Radiological Treatment

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Radiological Treatment for Liver Cancer

Many radiological treatment options exists for liver cancer:

1. Tumor ablation therapy

  • Radiofrequency ablation (RFA)
  • Percutaneous ethanol injection (PEI)
  • Microwave ablation
  • Cryo-ablation

2. Embolization therapy

  • Trans-arterial chemo-embolization (TACE)
  • Trans-arterial radio-embolization (TARE)

Tumor Ablation Therapy

Ablation is treatment that destroys liver tumors without removing them. These techniques are used in patients with a few small tumors and when surgery is not a good option (often because of poor health or reduced liver function). They are less likely to cure the cancer than surgery, but they can still be very helpful for some people. These treatments are also sometimes used in patients waiting for a liver transplant.

Ablation is best used for tumors no larger than about 3 cm across (a little over an inch). For slightly larger tumors (3 to 5 cm across), it may be used along with embolization. Because ablation often destroys some of the normal tissue around the tumor, it might not be a good choice for treating tumors near major blood vessels, the diaphragm, or major bile ducts.

People getting this type of treatment typically do not require a hospital stay. Often, ablation can be done without surgery by inserting a needle or probe into the tumor through the skin. The needle or probe is guided into place with ultrasound or CT scanning. Sometimes, though, to be sure the treatment is aimed at the right place, it may be done during surgery.

Possible side effects after ablation therapy include abdominal pain, infection in the liver, and bleeding into the chest cavity or abdomen. Serious complications are uncommon, but they are possible.

Radiofrequency ablation (RFA)

This procedure uses high-energy radio waves for treatment. The doctor inserts a thin, needle-like probe into the tumor. A high-frequency current is then passed through the tip of the probe, which heats the tumor and destroys the cancer cells. This is a common treatment method for small tumors.

Percutaneous ethanol injection (PEI)

This is also known as ethanol ablation. In this procedure, concentrated alcohol is injected directly into the tumor to kill cancer cells.

Microwave ablation

In this procedure, microwaves transmitted through the probe are used to heat and destroy the abnormal tissue.

Cryo-ablation

This procedure destroys a tumor by freezing it using a thin metal probe. The probe is guided into the tumor and then very cold gasses are passed through the probe to freeze the tumor, killing the cancer cells. This method may be used to treat larger tumors than the other ablation techniques, but it sometimes requires general anesthesia (where you are deeply asleep and not able to feel pain).

Embolization Therapy

Embolization is a procedure that injects substances to try to block or reduce the blood flow to cancer cells in the liver.

The liver is unusual in that it has 2 blood supplies. Most normal liver cells are fed by branches of the portal vein, whereas cancer cells in the liver are usually fed by branches of the hepatic artery. Blocking the branch of the hepatic artery feeding the tumor helps kill off the cancer cells, but it leaves most of the healthy liver cells unharmed because they get their blood supply from the portal vein.

Embolization is an option for some patients with tumors that cannot be removed by surgery. It can be used for tumors that are too large to be treated with ablation (usually larger than 5 cm across). It can also be used with ablation. Embolization does reduce some of the blood supply to the normal liver tissue, so it may not be a good option for some patients whose liver has been damaged by diseases such as hepatitis or cirrhosis.

Possible complications after embolization include abdominal pain, fever, nausea, infection in the liver, gallbladder inflammation, and blood clots in the main blood vessels of the liver. Because healthy liver tissue can be affected, there is a risk that liver function will get worse after embolization. This risk is higher if a large branch of the hepatic artery is embolized. Serious complications are not common, but they are possible.

Trans-arterial chemo embolization

In this procedure a catheter (a thin, flexible tube) is put into an artery through a small cut in the inner thigh and threaded up into the hepatic artery in the liver. A dye is usually injected into the bloodstream at this time to help the doctor monitor the path of the catheter via angiography, a special type of x-ray. Once the catheter is in place, chemotherapy is given through the catheter directly into the artery, then plugging up the artery with small particles injected into it. Often, TACEis done by using tiny beads that give off a chemotherapy drug for the embolization.

Trans-arterial radio-embolization

This technique combines embolization with radiation therapy and is sometimes known as trans-arterial radioembolization.This is done by injecting small beads (called microspheres) that have a radioactive isotope (yttrium-90) stuck to them into the hepatic artery. Once infused, the beads lodge in the blood vessels near the tumor, where they give small amounts of radiation to the tumor site for several days. The radiation travels a very short distance, so its effects are limited mainly to the tumor.

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